New-onset arrhythmias following transcatheter aortic valve implantation: a systematic review and meta-analysis.

Siontis, George C M; Praz, Fabien; Lanz, Jonas; Vollenbroich, René; Roten, Laurent; Stortecky, Stefan; Räber, Lorenz; Windecker, Stephan; Pilgrim, Thomas (2018). New-onset arrhythmias following transcatheter aortic valve implantation: a systematic review and meta-analysis. Heart (British Cardiac Society), 104(14), pp. 1208-1215. BMJ Publishing Group 10.1136/heartjnl-2017-312310

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OBJECTIVE To evaluate the prevalence and clinical impact of new-onset arrhythmias in patients following transcatheter aortic valve implantation (TAVI). METHOD We systematically identified studies reporting new-onset arrhythmias after TAVI other than atrioventricular conduction disturbances. We summarised monitoring strategies, type and prevalence of arrhythmias and estimated their effect on risk of death or cerebrovascular events by using random-effects meta-analysis. The study is registered withInternational prospective register of systematic reviews (PROSPERO) (CRD42017058053). RESULTS Sixty-five studies (43 506 patients) reported new-onset arrhythmias following TAVI. The method of arrhythmia detection was specified only in 31 studies (48%). New-onset atrial fibrillation (NOAF) (2641 patients), bradyarrhythmias (182 patients), supraventricular arrhythmias (29 patients), ventricular arrhythmias (28 patients) and non-specified major arrhythmias (855 patients) were reported. In most studies (52 out of 65), new-onset arrhythmia detection was limited to the first month following TAVI. The most frequently documented arrhythmia was NOAF with trend of increasing summary prevalence of 11%, 14%, 14% and 25% during inhospital, 30-day, 1-year and 2-year follow-ups, respectively (P for trend=0.011). Summary prevalence estimates of NOAF at 30-day follow-up differ significantly between studies of prospective and retrospective design (8% and 21%, respectively, P=0.002). New episodes of bradyarrhythmias were documented with a summary crude prevalence of 4% at 1-year follow-up. NOAF increased the risk of death (relative risk 1.61, 95% CI 1.35 to 1.98, I2=47%) and cerebrovascular events (1.79, 95% CI 1.24 to 2.64, I2=0%). No study commented on therapeutic modifications following the detection of new-onset arrhythmias. CONCLUSIONS Systematic identification of new-onset arrhythmias following TAVI may have considerable impact on subsequent therapeutic management and long-term prognosis in this patient population.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Praz, Fabien; Lanz, Jonas; Vollenbroich, René; Roten, Laurent; Stortecky, Stefan; Räber, Lorenz; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1468-201X

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

08 Feb 2018 09:18

Last Modified:

29 Jun 2018 01:31

Publisher DOI:

10.1136/heartjnl-2017-312310

PubMed ID:

29275399

Uncontrolled Keywords:

aortic stenosis atrial fibrillation bradyarrhythmias meta-analysis transcatheter valve interventions

BORIS DOI:

10.7892/boris.111051

URI:

https://boris.unibe.ch/id/eprint/111051

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